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APPLICATION FOR SANITATION PERMIT Permit No. ------------------" Cam]efe in Duplicate) J1 ...._� �..r...�..�.,_._ -Date Issued - Application is hereby made to'.fhe San Joaquin Local Health District for a permit to construct and i sta I he work herein described. This application is made in compliance with County Ordinance No. 549. 61- /// F ��6 JOB ADDRESS AND LOCATION__._ h-' __.,S�I _----- nrytl -7L Owner's Name---------------------- t - -'=-- - w=z= _ .---- -- Phone--6---3-_Y-yk Address----------------------------- z---- � ---'-----5 - ZG -'t71 1 h - Contractor's Name--------•----------------------n1t,7'y -- Phone ----------------------- Installation will serve: Residence [iliApartment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ Y `�'`�� Number of living units:'.__/_-"Nurrtber1o1f bedrooms __�-_____'Number'of baths _rf_____ Lot size _________ _ ____ ___ ______________ ________ _ 41 Water Su I Public's �stemj�Conirnun t �s sfem' Private De th to Water`Table ________ ft. PP Y�•r Y � � y � ❑� � ❑� p Character of soil to a depth of 3 feet: Sand ❑•o-Gravel ❑" Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [+Hardpan ❑ Previous Application Made: Yes ❑ No Ij New Construction: Yes P`�No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool Permitted if public'sewer.is'available'witbin 200 feet. t -; Septic Tank: Distance from nearest well- ---Distan�e from foundation__l�___________.Material__ ___ _ _____ _ ____ ____._____-_________. -„ No. of co�partments_._�r._________-___-_Size__�X4�(_3______=___Liquid depth-----�___-_..._ _Capacity___.M________ , Dis osal ield: Distance from nearest well..�'W11�__._Qistance from foundation___ __ p� � fS�__________.Distance to nearest lot line_�__�______ ' Number of lines------,' __!t�`�s-�"_------'�e`'th of each line------7-Q----- Width of trench--- r�-------------'-------- g m-'------- Type of filter material.-V_'10_ --------.---Depth of filter material____!'_9---------«__._Total length__- ZY0___________________________— p 9 See a e Pit: Distance to nearest well_____________________Distance from found ------- 1 ❑ Numberof pits.-------------=-------Lining material---:-, ---- i Size: Diameter------------------------Depth-------------------------------- CesspCesspool: ool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------__ Size: Diameter -- -----De ❑ --- �Pth----------------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well____________________" __.Distance from nearest buildin ❑ Distance to nearest lot line---------------------- Remodelingana/or repairing (describe---------------•-----------------------------------=---- -------------------------------------•-- --------------------------------------------------- : �. ---------------------- s i I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1: ordinances, State laws, a ru s and regulations of the San Joaquin Local Health District. w � r (Signed =' (Owner and/or Contractor) V- --------•--1 --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ I ----i-------------------------- DATE------'� � ----------------------------- REVIEWED • - REVIEWEDBY---------------------------F---------------- ------------------------------------ -----------y -------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED__.•-_-•__________._R t - -------------------------------------------- - --- -s----------------------- DATE--------------------`---------- ------ --------- Alterations and/or and/or recommendations:---- -------------------------------------------------t-------------------------------------------------------- -------------------------••------------- I I f ------------------------•--------------------- --------------------•-------------------------=----------------------------------------- ---•----------- -- •-- -------------------•---------------------••--------i------------- ----------- ------------------------------------------------------------------------------ -----•----------------------------------------- ------------------------------- ' ------------------------------------------------------ ----------------------- -------------------------------------------------- F '--------------------------------------- / f FINAL INSPECTION BY:.- ----- Date Com--` - ✓ j(---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streef 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 Revised 1.57 F.P.CO_ ' t